The Role of Gamification in FES-Based Rehabilitation Programs
Stroke rehabilitation is a long and often challenging process that requires patients to engage in repetitive exercises to regain motor function. Functional Electrical Stimulation (FES) has emerged as an effective rehabilitation tool, aiding in muscle activation through controlled electrical impulses. However, adherence to rehabilitation programs remains a challenge due to the repetitive and monotonous nature of traditional therapy. Gamification, the application of game design elements in non-game contexts, has shown promise in enhancing patient engagement and improving rehabilitation outcomes. This blog post explores the role of gamification in FES-based rehabilitation programs, backed by recent research findings.
What is Functional Electrical Stimulation (FES)?
FES is a technique that restores motor function in stroke survivors by applying electrical impulses to the skin, stimulating targeted nerves to induce controlled muscle movements. These impulses help retrain neural pathways, promoting the recovery of motor skills [1].
FES systems are categorised into two main types:
Open-loop FES: Pre-programmed patterns applied by therapists without patient feedback.
Closed-loop FES: Systems integrating brain-computer interfaces (BCI) or electromyogram (EMG) feedback, allowing for patient-initiated stimulation.
Gamification in Stroke Rehabilitation
Traditional rehabilitation programs often suffer from low patient adherence, with long-term participation rates as low as 23% [2]. Gamification addresses this issue by introducing game mechanics such as scores, rewards, and engaging virtual environments that make rehabilitation more interactive and enjoyable.
Patient Engagement and Motivation
A study by Deutsch et al. found that gamified rehabilitation significantly improved patient motivation, endurance, and compliance [3]. Gamified exercises also facilitate skill transference, ensuring that motor skills acquired during therapy translate into real-life functional improvements.
Virtual Reality (VR) and FES Integration
Combining VR with FES offers a compelling approach to rehabilitation. A systematic review by Minzatanu et al. (2024) found that FES combined with VR provided superior motor recovery outcomes compared to conventional therapy. Immersive VR experiences create realistic and engaging environments, increasing neural activation and enhancing therapy effectiveness [4].
The Impact of Gamification on BCI Rehabilitation
BCI-driven rehabilitation systems use electroencephalography (EEG) signals to detect mental imagery of movement, triggering FES to assist in executing motor actions. A study by de Castro-Cros et al. (2020) explored the impact of gamification on BCI rehabilitation and found that while gamification did not alter the efficacy of motor imagery, it significantly improved patient experience, making therapy more enjoyable [5].
EEG signals are electrical signals generated by brain activity, recorded using electrodes placed on the scalp. In rehabilitation, EEG signals can be used to detect brain activity related to movement, helping to control Functional Electrical Stimulation (FES) or virtual environments to assist motor recovery.
Case Study: Gamification in BCI-FES Systems
In a pilot study, a game was designed where stroke patients controlled an avatar to protect cheese from a rat using wrist movements. This narrative-driven approach enhanced engagement without negatively impacting motor training accuracy [5]. Such findings underscore the potential of gamification in making repetitive rehabilitation tasks more tolerable and engaging.
Gamification represents a promising advancement in FES-based stroke rehabilitation by increasing patient engagement and adherence. Integrating VR and BCI technologies further enhances the rehabilitation experience, ensuring greater effectiveness in restoring motor function.
References:
[1] Physiopedia. (2024). Gaming Technology in Neurological Rehabilitation. Retrieved from https://www.physio-pedia.com/Gaming_Technology_in_Neurological_Rehabilitation
[2] Sluijs EM, Kok GJ, van der Zee J. Correlates of exercise compliance in physical therapy. Physical Therapy. 1993; 73 (11):771-786.
[3] Deutsch JE, Borbely M, Filler J, Huhn K, Guarrera-Bowlby P. Use of a low-cost, commercially available gaming console (Wii) for rehabilitation of an adolescent with cerebral palsy. Journal of the American Physical Therapy Association. 2008; 88: 1196-1207.
[4] Minzatanu, D., Roman, N. A., Manaila, A. I., Baseanu, I. C. C., Tuchel, V. I., Basalic, E. B., & Miclaus, R. S. (2024). Virtual Reality Associated with Functional Electrical Stimulation for Upper Extremity in Post-Stroke Rehabilitation: A Systematic Review. Applied Sciences, 14(8248). doi:10.3390/app14188248
[5] de Castro-Cros, M., Sebastian-Romagosa, M., Rodríguez-Serrano, J., Opisso, E., Ochoa, M., Ortner, R., Guger, C., & Tost, D. (2020). Effects of Gamification in BCI Functional Rehabilitation. Frontiers in Neuroscience, 14:882. doi:10.3389/fnins.2020.0088